Do sodium glucose co-transporter-2 (sglt-2) inhibitors affect lower urinary tract, sleep and quality of life in people with type 2 diabetes?

Abstract

Purpose: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are primarily preferred in patients with type 2 diabetes. The purpose of this paper was to elucidate the effects of SGLT-2 inhibitor use on patients' voiding habits, sleep, and quality of life. Methods: Our study involved patients with type 2 diabetes who had an SGLT2 inhibitor added to their current treatment. The frequency of day-night urination, lower urinary tract symptoms, sleep and quality of life were assessed both prior to initiation of the treatment and during subsequent 1st and 3rd months. Results: The study included 38 women and 34 men. At the third month after SGLT-2 inhibitor had been added, there was a significant decrease in HbA1c, triglyceride and microalbumin levels (p<0.05). There was no increase in voiding frequency (day/night) and there was no difference in the evaluation of lower urinary tract symptoms, but voiding volumes increased in uroflowmetry. When the short form-36 (SF-36) scale was examined, there was a significant improvement in physical function, one of the sub-parameters (p = 0.01). The factor affecting this most, was the improvement in HbA1c. Conclusion: This paper suggests that SGLT-2 inhibitors don’t increase voiding frequency and don’t cause an increase in lower urinary tract symptoms.

Keywords

• Sodium-glucose cotrasporter-2 inhibitor
• lower urinary tract symptoms
• nocturia
• quality of life
• type 2 diabetes.

References

1. American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care 2014;37 Suppl 1:S14-S80.
2. Clar C, Gill JA, Court R, Waugh N. Systematic review of SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes. BMJ Open 2012;2(5):e001007.
3. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015;373(22):2117-2128.
4. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 2017;377(7):644-657.
5. Shikuma J, Ito R, Sasaki‐Shima J, et al. Changes in overactive bladder symptoms after sodium glucose cotransporter‐2 inhibitor administration to patients with type 2 diabetes. Practical Diabetes 2018 Mar;35(2):47-50.
6. Şahin S, Haliloğlu Ö, Polat Korkmaz Ö, et al. Does treatment with sodium-glucose co-transporter-2 inhibitors have an effect on sleep quality, quality of life, and anxiety levels in people with Type 2 diabetes mellitus? Turk J Med Sci 2020;51(2):735-742.
7. Gungor F, Yasa C, Yuksel Ozgor B, et al. Validation of the Turkish version of the ICIQ-FLUTS, ICIQ-FLUTS long-form, ICIQ-LUTS quality-of-life, and ICIQ-FLUTS sexual functions. Neurourol Urodyn 2020;39(3):962-968.
8. Mertoğlu O, Üçer O, Ceylan Y, et al. Reliability and Validity of the Turkish Language Version of the International Consultation on Incontinence Questionnaire - Male Lower Urinary Tract Symptoms. Int Neurourol J 2016;20(2):159-163.

9. Kocyiğit H, Aydemir O, Fisek G, Olmez N, Memiş A. Kısa Form- 36 (KF-36)’nın Turkce versiyonunun guvenilirliği ve gecerliliği. İlac ve Tedavi Dergisi 1999; 12:102- 6.
10. Abraham L, Hareendran A, Mills IW, et al. Development and validation of a quality-of-life measure for men with nocturia. Urology 2004;63(3):481-486.
11. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008;12(2):161-168.
12. Dekkers CCJ, Gansevoort RT, Heerspink HJL. New Diabetes Therapies and Diabetic Kidney Disease Progression: the Role of SGLT-2 Inhibitors. Curr Diab Rep 2018;18(5):27.
13. Chilelli NC, Bax G, Bonaldo G, et al. Lower urinary tract symptoms (LUTS) in males with type 2 diabetes recently treated with SGLT2 inhibitors-overlooked and overwhelming? A retrospective case series. Endocrine 2018;59(3):690-693.
14. Kabadi UM. SGLT2 inhibitors: far too many cautions and alerts and limited efficacy. J Diabetes Metab Disord Control 2016;3(5):90-94.
15. Guo Z, Wang L, Yu J, Wang Y, Yang Z, Zhou C. The role of SGLT-2 inhibitors on health-related quality of life, exercise capacity, and volume depletion in patients with chronic heart failure: a meta-analysis of randomized controlled trials [published correction appears in Int J Clin Pharm 2023;45(3):547-555.
16. Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev 1999;15(3): 205-218.
17. Liu J, Li L, Li S, et al. Effects of SGLT2 inhibitors on UTIs and genital infections in type 2 diabetes mellitus: a systematic review and meta-analysis. Sci Rep 2017;7(1):2824.